Statement Of Partial Unemployment - Virginia Employment Commission

Download a blank fillable Statement Of Partial Unemployment - Virginia Employment Commission in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Statement Of Partial Unemployment - Virginia Employment Commission with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

VIRGINIA EMPLOYMENT COMMISSION

STATEMENT OF PARTIAL UNEMPLOYMENT

NOTICE TO EMPLOYER:

Complete this form and give it to the worker as instructed in Form VEC-B-32, NOTIFICATION OF CLAIM(S) FILED FOR

BENEFITS, within 7 days for all weeks ending since the effective date of the claim, and thereafter, within 14 days after each pay

period covering calendar weeks in which the worker earns less than his/her weekly benefit amount because of lack of work.

Form VEC-B-32 shows effective date and weekly benefit amount. Complete online and print or by typewriter or in ink. Record

gross wages for actual work and holiday/vacation pay separately, indicating type of pay for holiday or vacation pay. Enter under

“DATE ABSENT” the date(s) the worker did not work when work was available and note the reason if known.

(Online, hover over text box for help). BE SURE TO SIGN THE COMPLETED FORM.

Click Here for Instructions

During the week(s) covered by this statement this individual worked, but less than full-time, and earned less than his/her weekly

benefit amount due to a lack of work.

WORKER’S NAME _______________________________

SOCIAL SECURITY NUMBER _______--_____--________

WEEK NUMBER ONE

WEEK NUMBER TWO

SUNDAY __________ THROUGH SATURDAY _________

GROSS WAGES:_________________________________

GROSS WAGES: ________________________________

HOLIDAY/VACATION PAY: ________________________

DATES ABSENT (BUT AVAILABLE WORK)

DATE

REASON ABSENT

DATE

REASON ABSENT

________________________________________________

_______________________________________________

________________________________________________

_______________________________________________

________________________________________________

_______________________________________________

________________________________________________

_______________________________________________

I certify that, to the best of my knowledge, the above is true and correct.

Employer ____________________________________ VEC Acct # ___________________ Date to Worker_______________

By ____________________________________________Title_______________________ Contact Phone #______________

NOTICE TO WORKER: To avoid delay of any payment due to you, you must mail this statement immediately upon completion

to Virginia Employment Commission, Benefit Payment Charge Unit, PO Box 2249, Richmond, Virginia. 23218.

You are required to complete the following section if you worked for any other employer during the weeks being claimed.

OTHER EMPLOYMENT AND WAGES: List below the names and addresses of any other employer(s) you worked for and the

gross wages that you earned during the above week(s), including earnings from self employment. Enter “None” if you earned no

other wages in the above week(s).

WEEK ONE

WEEK TWO

Employer & Address

Wages

Employer & Address

Wages

____________________________________________

_________________________________________________

____________________________________________

_________________________________________________

____________________________________________

_________________________________________________

____________________________________________

_________________________________________________

I hereby file this claim for partial unemployment benefits for the week(s) above. I certify that I have earned no wages other than those shown above during the

week(s) covered by this statement. I certify that the statements made in connection with this claim are true to the best of my knowledge. I understand that

knowingly providing false or misleading information or withholding material information constitutes a Class1 misdemeanor that could result in a fine, a jail

sentence, or both. In addition, I understand that I will be liable for a 15% penalty on any amount of benefits erroneously paid due to my providing false or misleading

information to obtain benefits.

Worker’s signature_____________________________ Signed at _______________________Date signed_____________

City or County & State

VEC-B-31 (Revised 3/2014)